Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Friday, September 27, 2013

The truth of the matter is any surface or fomite has the
potential to transmit pathogenic bacteria, viruses or fungi. However, the effectiveness of transmission and likelihood any surface in particular could be directly linked to
transmission and ultimately lead to infection are two entirely different
things. Equate transmission to
transportation. A bicycle will get you
to from point A to point B faster than walking, but the 2014 Porsche 911 Turbo which can go from 0 - 60 in 3.2 seconds is the obvious winner in terms of speed
of getting you from point A to point B.

Similar to the differences in effectiveness of
transportation between bicycles and sports cars, there are distinct differences
in the effectiveness of transmission between hard, non-porous surfaces such as
glass, laminates or smooth plastics and porous, soft surfaces such as privacy
curtains, lab coats and bed linens.

There is evidence to support the fact that hard,
non-porous surfaces such as tables, door handles or toilets are far more
effective in transferring germs from their surfaces to the hands of healthcare
workers (HCWs) than soft, porous
surfaces like fabrics. Just using a
little common sense can see how this would be true. Fabrics, sponges and other porous, soft
surfaces by their very nature have crevices, pits or divots. What better place for germs to hide. Have you ever used a sponge to paint or
stamp? When you apply paint to the
sponge and then press it to a surface does the paint spread uniformly? No.
There are pockets of the surface that the colour did not transfer. The reason?
The paint was hiding in the crevices.
Similarly, these crevices decrease the effectiveness of germs
transferring to hands of HCWs.

Now picture a hard, non-porous surface such as a table or
plastic touch screen. Such surfaces do
not offer the same crevices for germs to hide.
If you were to use a plastic square to stamp what would happen? The paint would cover the surface uniformly
and when you then pressed that plastic square to a surface you would get a
nice, uniform square of colour. From an
infection transmission perspective a hard non-porous surface provides a far
more effective transfer of germs to hands.

A 2001 study by Sattar et al. investigated how bacteria
is transferred from fabrics to hands and then to other fabrics again. I particularly like this study because the
research team applied a quantitative protocol for assessing the transfer of
bacteria from fabrics of 100 percent cotton and a 50-50 cotton/polyester blend
to fingerpads or other pieces of fabric.
Transfer from fabric to fabric was performed by direct contact using
moist and dry fabrics. Transfers from fabrics to fingerpads of adult volunteers
were tested using moist, dry and re-moistened pieces of the fabrics, with or
without friction during the contact. Bacterial transfer from fabrics to
moistened fingerpads was also studied.
Sattar and his team concluded that bacterial transfer from moist donor
fabrics using recipients with moisture was always higher than that to and from
dry ones. Further, friction increased
the level of transfer from fabrics to fingerpads by as much as fivefold.
Bacterial transfer from poly/cotton was consistently higher when compared with
that from all-cotton material.

What does this all mean?
Well, we know that germs are able to be survive on soft surfaces such as
fabrics, and certainly there is evidence that they can be transferred from
fabric to hand or fabric to fabric. But,
transfer was most successful when fabric or hands were wet. How often to HCWs touch patients with wet
hands/gloves? Are soft surfaces a true
concern for infection prevention or are we simply hypothesizing that based on
findings from a few studies that have show germs can live and survive on soft
surfaces that such surfaces MUST then be the reservoir for all the transmission
we see in hospitals? Personally, I think
not. Hard, non-porous surfaces are still
by far the most efficient in transferring and thereby transmitting
disease. I think we need to take a
harder look at all of those pieces of shared patient care equipment and really
investigating who is cleaning them (if in fact they are being cleaned) and how
they are contributing to the spread of HAIs.

Stay tuned for next week's blog...... A New Claim on the
Block! Can you guess where I'm going
with this?

Tuesday, September 17, 2013

The fall tradeshow and conference season is in full
swing. As I write this blog I am waiting
for the opening ceremonies of Exchange 2013 (Association for the Healthcare
Environment's (AHE) annual conference).
Could there be a better place to learn about cleaning and disinfection
than a convention with delegates whose day to day responsibility is
environmental hygiene?

I am not certain what I find more concerning at
tradeshows; delegates running from booth to booth in search of a knight in
shining armour (aka the next silver bullet) or the noise permeating from
vendors as to why their product is the answer to every facilities problems.
I wonder sometimes if in today's society where we see technological
advancements as the answer to everything if we forget that sometimes getting
back to basics can in fact improve outcomes as much (OR BETTER) than trying to
implement some new fangled gizmo.

The research team conducted a prospective study that
included three interventions: 1) the use of fluorescent markers applied to
high-touch surfaces in patient rooms to provide monitoring and feedback on
thoroughness of cleaning; 2) utilization of an automated ultraviolet (UV)
radiation device as a complementary disinfection strategy used after cleaning;
and 3) an enhanced disinfection process composed of a dedicated daily
disinfection team and a process requiring supervisory assessment and clearance
of terminally-cleaned C. difficile infected rooms. The study was designed in
such a fashion that each strategy built on the previous one.

In order to determine the effectiveness of the
interventions, environmental cultures were obtained from rooms contaminated
with C. difficile after cleaning and disinfection. The first intervention using fluorescent markers saw modest improvement in
the disinfection of high-touch surfaces over traditional cleaning practices (57
percent versus 67 percent). When UV devices were introduced in the second
intervention there was a further reduction in the percentage of positive
cultures, but C. difficile still was present in 35 percent of rooms.
However, the impact from implementing an enhanced cleaning and disinfection
team dramatically improved the outcome by reducing positive cultures to 7
percent!

What?! Did I just
read that improving cleaning worked better than implementing a new fangled
gizmo that we were hoping would be the answer to all of our environmental
hygiene problems?

Yup! As the study
concluded "Ultimately, disinfection was dramatically improved through
formation of a dedicated daily disinfection team and implementation of a
standardized process for clearing CDI rooms."

I still look forward to walking the AHE Exhibitor hall
and picking up the materials on all of the latest and greatest products, but I
will certainly make sure I take the time to wade through the noise of what I
heard from the sales reps to make my own informed decision on what I think is
the latest and greatest advancement to environmental hygiene. I hope for those of you reading this blog,
you'll go back and take a look at what your environmental services team is
doing. Perhaps you already have your
knight in shining armour, he may need some polishing but perhaps you've had the
answer to your environmental hygiene problems under your roof the entire
time. Let's go back to basics and
remember that cleaning and disinfection does and can work. We just need to support our environmental
services staff and promote them for the heroes they really are!

Thursday, September 12, 2013

One of the joys of travelling is never truly knowing if
you're going to get home when you hope to.
Yesterday, was one such day. Rush
hour traffic was in my favour, I made it from New Haven, CT to Hartford in
about an hour and even had time to enjoy a relatively "nice" dinner
and glass of red wine. Then Mother
Nature hit leaving me stranded in the Bradley International Airport in
Hartford, CT yesterday for 4 hours due to weather conditions - apparently it's
a health hazard to have ground crew servicing planes during thunder and
lightning storms. For anyone travelling
via Hartford, I would like to point out that the stores and restaurants close
by 8pm!!! so, if there is even the REMOTEST chance you're plan may delayed and
you may get hungry or thirsty later - stock up, even if you do not think you'll
need it!

The upside of sitting around in airports is that you get
the opportunity to catch up on your reading and yesterday I had the perfect
opportunity to peruse some of the blogs I loyally follow. As introduced back in January, one of the ways
we want to educate is through sharing of blogs that we think are noteworthy and
worth following. Social Media whether
through blogging or tweeting or any other forum is about having a conversation
on topic that is of interest to you! The
Talk Clean To Me we focus on topics related to the use of Chemical
Disinfectants and Infection Prevention – this is the stuff we know and know
well. This week I’m taking the concept
of #FF to the Blog-Sphere and want to introduce to a couple of blogs that I
think are worth following!

CDC's Safe Healthcare where "opinions expressed are
those of its authors and may not represent the official positions of the
Centers for Disease Control and Prevention or the Department of Health and
Human Services" shares experiences from the trenches covering virtually
any topic an IP may be interested in.
You never know, you may find the answer to your current infection
prevention dilemma!

Hand Hygiene, Infection Prevention and Food Safety Blog
by the DEB Group, a leading company in hand hygiene and skin care products,
leverages their relationships with experts around the world to provide weekly
blogs on topics pertaining to hand hygiene, infection prevention and food
safety. You may recognize the blog they
posted this week if you read the Talk Clean To Me blog we posted a few weeks
back on School Absenteeism!

That’s it for this #FF!
I hope you turn on your inner geek and check out some of these blogs!

Thursday, September 5, 2013

When I first started collecting my thoughts for this
week’s blog post on Occupational Asthma and the potential contributing role
played by cleaning and disinfectant products, the final lyrics from the chorus
of Maroon 5’s 2002 hit “Harder to Breathe” rang clearly in my head, “it’s
getting harder and harder to breathe!”.
For many professionals in the cleaning industry, this statement has the
potential to ring true over the span of their careers.

In the USA, several states conduct work related asthma
surveillance as part of the Sentinel Event Notification System for Occupational Risks (SENSOR). The surveillance system
in California showed that custodians and cleaners had the highest incidence of
work related asthma. Furthermore,
Rosenman et al reported that a cleaning product was 1 or more of the 3
suspected agents identified in 12% of the confirmed cases that they
reviewed. The fact that bleach was the
most frequently identified product should not be all that surprising considering
that bleach was recently designated an asthma-causing agent by the Association
of Occupational and Environmental Clinics (Sastre 2011).

Quaternary ammonium compounds (Quats or QACs) also tend
to be frequently identified as potential asthma causing agents due to their
prevalence in numerous cleaning and disinfectant products. Michigan’s SENSOR program published a
detailed report on the link between asthma and quats in their 2008-2009
newsletter (http://www.oem.msu.edu/userfiles/file/News/v20n1.pdf). The newsletter includes several case reports
and a review of several peer reviewed studies completed on the subject.

This past summer, Massachusetts’ Dept. of Health issued
an Occupational Lung Disease Bulletin as part of their SENSOR program
(http://www.mass.gov/eohhs/docs/dph/occupational-health/sensor-lung-disease-bulletins/summer2013.pdf). This bulletin further detailed the potential
link between the use of certain cleaning and disinfectant products and
work-related asthma but also included valuable recommendations related to the
correct use of cleaning products and the consideration of safer disinfectant
chemistries. The bulletin states that
“The prevention goal is to balance the two needs—to reduce infectious disease
transmission without causing chemical related disease”. Ensuring that disinfectants are not overused,
unnecessarily aerosolized or misted into the air, and employed at the correct
concentration are important points to consider.
The bulletin also includes reference to the consideration of safer
disinfectants: “EPA’s Design for the Environment (http://www.epa.gov/dfe/) has
begun promoting use of safer disinfectants that pose lower risks of adverse
human effects and environmental degradation. To date, the active ingredients
approved as safer include citric acid, lactic acid and hydrogen peroxide”.

In summary, where the use of disinfectants are necessary,
steps should be taken to reduce the potential exposure to harmful and
potentially asthma causing chemicals by considering safer cleaning and
disinfectant options or by employing practices and protocols that will reduce a
user’s direct contact and risk.